2000年至2020年期间，15个国家中大于胎龄儿和巨大儿活产的新生儿死亡风险，包括全国范围内1.156亿条关联记录。

Neonatal mortality risk of large-for-gestational-age and macrosomic live births in 15 countries, including 115.6 million nationwide linked records, 2000-2020.

作者信息

Suárez-Idueta Lorena, Ohuma Eric O, Chang Chia-Jung, Hazel Elizabeth A, Yargawa Judith, Okwaraji Yemisrach B, Bradley Ellen, Gordon Adrienne, Sexton Jessica, Lawford Harriet L S, Paixao Enny S, Falcão Ila R, Lisonkova Sarka, Wen Qi, Velebil Petr, Jírová Jitka, Horváth-Puhó Erzsebet, Sørensen Henrik T, Sakkeus Luule, Abuladze Lili, Yunis Khalid A, Al Bizri Ayah, Alvarez Sonia Lopez, Broeders Lisa, van Dijk Aimée E, Alyafei Fawziya, AlQubaisi Mai, Razaz Neda, Söderling Jonas, Smith Lucy K, Matthews Ruth J, Lowry Estelle, Rowland Neil, Wood Rachael, Monteath Kirsten, Pereyra Isabel, Pravia Gabriella, Lawn Joy E, Blencowe Hannah

机构信息

Mexican Society of Public Health, Mexico City, Mexico.

Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.

出版信息

BJOG. 2023 Nov 27. doi: 10.1111/1471-0528.17706.

DOI:10.1111/1471-0528.17706

PMID:38012114

Abstract

OBJECTIVE

We aimed to compare the prevalence and neonatal mortality associated with large for gestational age (LGA) and macrosomia among 115.6 million live births in 15 countries, between 2000 and 2020.

DESIGN

Population-based, multi-country study.

SETTING

National healthcare systems.

POPULATION

Liveborn infants.

METHODS

We used individual-level data identified for the Vulnerable Newborn Measurement Collaboration. We calculated the prevalence and relative risk (RR) of neonatal mortality among live births born at term + LGA (>90th centile, and also >95th and >97th centiles when the data were available) versus term + appropriate for gestational age (AGA, 10th-90th centiles) and macrosomic (≥4000, ≥4500 and ≥5000 g, regardless of gestational age) versus 2500-3999 g. INTERGROWTH 21st served as the reference population.

MAIN OUTCOME MEASURES

Prevalence and neonatal mortality risks.

RESULTS

Large for gestational age was common (median prevalence 18.2%; interquartile range, IQR, 13.5%-22.0%), and overall was associated with a lower neonatal mortality risk compared with AGA (RR 0.83, 95% CI 0.77-0.89). Around one in ten babies were ≥4000 g (median prevalence 9.6% (IQR 6.4%-13.3%), with 1.2% (IQR 0.7%-2.0%) ≥4500 g and with 0.2% (IQR 0.1%-0.2%) ≥5000 g). Overall, macrosomia of ≥4000 g was not associated with increased neonatal mortality risk (RR 0.80, 95% CI 0.69-0.94); however, a higher risk was observed for birthweights of ≥4500 g (RR 1.52, 95% CI 1.10-2.11) and ≥5000 g (RR 4.54, 95% CI 2.58-7.99), compared with birthweights of 2500-3999 g, with the highest risk observed in the first 7 days of life.

CONCLUSIONS

In this population, birthweight of ≥4500 g was the most useful marker for early mortality risk in big babies and could be used to guide clinical management decisions.

摘要

目的

我们旨在比较2000年至2020年期间15个国家1.156亿例活产中，大于胎龄儿（LGA）和巨大儿的患病率及新生儿死亡率。

设计

基于人群的多国研究。

背景

国家医疗保健系统。

研究对象

活产婴儿。

方法

我们使用了为脆弱新生儿测量协作组确定的个体水平数据。我们计算了足月+LGA（>第90百分位数，数据可得时也计算>第95和>第97百分位数）与足月+适于胎龄儿（AGA，第10 - 90百分位数）相比，以及巨大儿（≥4000、≥4500和≥5000克，无论胎龄）与2500 - 3999克相比的新生儿死亡率的患病率和相对风险（RR）。INTERGROWTH 21st作为参考人群。

主要观察指标

患病率和新生儿死亡风险。

结果

大于胎龄儿很常见（中位患病率18.2%；四分位间距，IQR，13.5% - 22.0%），总体而言与AGA相比新生儿死亡风险较低（RR 0.83，95%CI 0.77 - 0.89）。约十分之一的婴儿≥4000克（中位患病率9.6%（IQR 6.4% - 13.3%），1.2%（IQR 0.7% - 2.0%）≥4500克，0.2%（IQR 0.1% - 0.2%）≥5000克）。总体而言，≥4000克的巨大儿与新生儿死亡风险增加无关（RR 0.80，95%CI 0.69 - 0.94）；然而，与2500 - 3999克的出生体重相比，≥4500克（RR 1.52，95%CI 1.10 - 2.11）和≥5000克（RR 4.54，95%CI 2.58 - 7.99）的出生体重观察到更高的风险，在出生后的前7天风险最高。